Chronic Pain Consultation

Chronic Pain Consultation Chief Complaint: The patient was seen for chronic lower back pain that has persisted for over six months, significantly affecting daily activities and quality of life. Subjective: The patient reports a dull, aching pain in the lower back that occasionally radiates to the left leg. The pain is exacerbated by prolonged sitting and standing. The patient has tried over-the-counter pain medications with minimal relief. The patient is seeking advice on alternative pain management strategies. Past Medical History: The patient has a history of hypertension and underwent an appendectomy in 2010. Medications: 1. Lisinopril 10 mg daily 2. Ibuprofen 400 mg as needed for pain Allergies: No known drug allergies. Social History: The patient is a 45-year-old office worker originally from the UK, now residing in Australia. The patient is married with two children and enjoys cycling and swimming during weekends. Sleep History: The patient reports difficulty falling asleep due to pain, averaging about 5 hours of sleep per night. No history of snoring or sleep apnea. Objective: Physical examination reveals tenderness in the lumbar region with limited range of motion. Vital signs are stable. Recent MRI shows mild disc degeneration at L4-L5. Assessment: 1. Chronic lower back pain likely due to disc degeneration. 2. Differential diagnosis includes lumbar radiculopathy. Plan: 1. Medications: - Continue Lisinopril. Start Gabapentin 300 mg at night for neuropathic pain. Discussed potential side effects such as dizziness and drowsiness. 2. Physical Activity: - Advised on low-impact exercises such as swimming and yoga. Referred to a physiotherapist for tailored exercise program. 3. Interventional Procedures: - Discussed the possibility of nerve blocks if conservative measures fail. Explained the concept of central sensitization and its role in chronic pain. 4. Mindfulness: - Encouraged the patient to explore mindfulness and meditation techniques for pain management. 5. Surgery: - Surgery is not indicated at this time. Will reassess if symptoms worsen. 6: Patient Education: At today's visit, we discussed central sensitization. Central sensitization is a condition of the nervous system that is associated with the development and maintenance of chronic pain. When central sensitization occurs, the nervous system goes through a process called wind-up and gets regulated in a persistent state of high reactivity. This persistent, or regulated, state of reactivity lowers the threshold for what causes pain and subsequently comes to maintain pain even after the initial injury might have healed. We talked about the mechanism of interventions of chronic pain that are geared towards a reduction in pain as measured by pain scores and subjective reporting. We also discussed measurements of improvement via sleep, mood and physical functioning.